Provider Demographics
NPI:1851912844
Name:EGGLESTON, ROBERT LEWIS III (MA, LLPC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEWIS
Last Name:EGGLESTON
Suffix:III
Gender:M
Credentials:MA, LLPC
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Mailing Address - Street 1:926 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-1500
Mailing Address - Country:US
Mailing Address - Phone:616-635-7467
Mailing Address - Fax:
Practice Address - Street 1:741 KENMOOR AVE SE STE B
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-2304
Practice Address - Country:US
Practice Address - Phone:616-425-2412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018202101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional